Archive for November, 2009
You finally can get an H1N1 swine flu shot, no matter who you are.
The Pueblo City-County Health Department has scheduled two swine flu clinics for the general public, not just for people with a higher risk for the disease.
The first clinic will be held Saturday and the second will be held Dec. 12.
The health department is offering the vaccine shots and doses of nasal mist for free, according to spokeswoman Sara Bruestle. You do not need to bring identification, an insurance card or anything else. The vaccines are being paid for with federal funds given to the health department. The department has held several clinics since the H1N1 swine flu broke out this fall. But those were available only to people in high-risk groups because of the limited supply of vaccine.
That’s not a problem anymore, Bruestle said. The department can give up to 2,500 doses of the vaccine Saturday, either by shot or by nasal mist.
The department will be getting another shipment of the vaccine next week, so there will be plenty of vaccine for the Dec. 12 clinic too, she said.
Thousands of people turned out for earlier flu vaccine clinics and the health department expects large crowds for the two Saturday clinics, Bruestle said. The department has hired security and organized its paperwork and vaccination areas at the schools to keep people from being crowded together during the cold and flu season. People who want a vaccination should come to the main doors and be prepared to stand in line. There will be no seating. Anyone who needs oxygen or a wheelchair should bring those, although some wheelchairs will be available.
The average wait for a vaccination has been between 45 minutes and an hour, Bruestle said. She suggested bringing a snack or eating something before coming and to remain patient.
She cautioned people against lining up too early, saying some people have come as early as 7 a.m.
“We don’t open the doors until we are ready at 10 a.m.,” she said. “We ask that they don’t show up that early (at 7 a.m.), because it’ll be very cold.”
The lines usually have tapered off after lunch, Bruestle said, so she suggested not coming until later.
Jennifer Ludwig, head of the health department’s prevention and preparedness department, said some people have opted for the nasal mist to avoid the pain of a shot. Others have asked for a shot because of concerns that the nasal mist contains live flu virus, though it is very much weakened.
People with asthma should not have the nasal mist, she said, because it can trigger an asthma attack.
Neither vaccination is recommended for people who are ill, who have certain underlying medical conditions, who have had a live vaccine in the last 30 days or who are allergic to eggs.
The clinics would be a good time to get the second dose recommended for children 9 and younger who already have received one dose. Parents also can call and make an appointment to get a second dose at the health department’s office, 101 W. Ninth St., by calling the Public Health Flu Hotline at 583-4440 between 10 a.m. and 2 p.m. Tuesday through Friday.
Bruestle said the department will have signs at schools reinforcing the message.
The swine flu has hit children the most, but Ludwig said you should bring your children even if they’ve been sick with something this fall or winter. There have been too many varieties of colds and flu going around to know for sure if your child has had the H1N1 flu and “it won’t hurt anything to get vaccinated even if they had the flu.”
Ludwig said the flu has started to affect more older people, according to informal local and state reports. This is the first chance for those people to be vaccinated.
Above all, health officials asked people who come to be patient. There will be plenty of vaccine and the lines will move along, even if it doesn’t always feel like it.
I hope you all had a wonderful Thanksgiving. Now that that’s over, Congress is back in session, and the Senate is tackling the health care reform issue.
One of the things that is being discussed in reforming our health insurance system is allowing people to buy insurance plans from other states where they might be able to find less expensive plans. I’m not sure how this is supposed to work, and here’s why.
One reason the cost of plans is lower in some states than is others is the number of mandated services a health plan is required to cover. The more a plan is required to cover, the higher the cost of coverage. For example, California has 56 required services that each plan must cover. By contrast, Idaho has 13 state mandates. We aren’t at the top of the list by any means; Virginia has 60 mandates and Maryland has 66. Want to check out what kinds of things are mandated, click here.
Another area that needs to be addressed is how physicians and others are paid. HMO plans in California tend to be more expensive than PPO plans in the individual market, but you have lower out of pocket costs when obtaining care on an HMO plan. (The opposite is usually true in group health insurance.) The reason this can be is through very specific networks of contracted doctors. Most people know that you don’t have coverage if you go outside the HMO network unless it’s an emergency. So maybe you just don’t offer HMOs between states. But PPOs have networks too. If you see a contracted doctor you are covered at a higher level than non-contracted doctors. So if you are in California and buy a plan from Kansas, would you always be covered at the lower reimbursement rates? Larger carriers like United Healthcare and Aetna have networks in most states, but what about the smaller, regional carriers without networks in other states? How would that work?
Another aspect of provider payment that affects premiums is how much providers are paid. Care in some states is less expensive than others, so how do you pay providers in the ‘expensive’ states versus the less expensive, and what will that do to the cost of insurance in those states where lower costs of care are factored into the cost of insurance? You could still end up with the problem of some people being ‘under insured’ depending on how reimbursement is worked out.
So be careful what you ask for, you may gt it. The more you want covered in a plan, the more it’s going to cost. Just remember the old marketing adage, if it sounds too good to be true, it usually is.
There are many facets to the world of mental health, especially when it comes to health insurance and finding adequate coverage for a variety of afflictions and disorders. We’ve put together some answers to some of the more common questions revolving around these topics for you below.
Do most health plans include mental health coverage? The answer, simply put, is yes. The vast majority of insurers and health plans cover at least a limited amount of mental health care.
According to a recent employer survey published in the journal Health Affairs:
•91 percent of small firms (10-499 employees) and 99 percent of large firms offer mental health and substance abuse coverage in their most used medical plans.
•Mental health and substance abuse coverage was included in 87 percent of indemnity plans, 88 percent of HMOs, 97 percent of Point of Service (POS) plans and 93 percent of Preferred Provider Organizations (PPOs).
It is commonly acknowledged today, in 2006, that most employees who have employer-based health insurance have access to mental health coverage, and many of the employees who don’t have coverage have simply chosen not to join an employer’s plan that includes mental health services.
Does mental health coverage cost more? Yes, this is generally the case. There are limits to mental health coverage and the reason why most employers impose limits is due to cost. Estimates vary widely of how much more mental health coverage costs. Here are some results from some studies:
•A 1998 study sponsored by National Advisory Mental Health Council (NAMHC) Parity Workgroup, a division of the federal National Institute of Mental Health, estimated that mental health services would add less than 1 percent to the cost of a health insurance policy for an HMO.
•A 1998 study by Mathematica estimated a 3.6 percent increase across all plans, with a range of 0.6 percent increase for HMOs up to a 5 percent increase for fee-for-service plans.
•A 1997 analysis by the actuarial firm Milliman & Robertson for the National Center for Policy Analysis, examining the cost of a typical mental health mandate (not specific legislation), concluded that mental health services parity legislation tends to drive up costs by 5 percent to 10 percent.
With regard to mental insurance in general, how do insurance companies treat mental illness? Insurance companies tend to be somewhat wary of mental health claims due to the increase of fraudulent claims. When Medicare looked for fraud in the community mental health centers last year, it barred 80 of them in nine states from participating in the program.
The Health Care Financing Administration (HCFA), which administers Medicare, knew something was amiss when the average yearly cost for each senior getting mental health services jumped from $1,642 in 1993 to more than $10,000 by 1997.
Medicare administrator Nancy-Ann DeParle contended at the time that 90 percent of the patients had no mental illness serious enough to qualify for special treatment.
That being said, it’s straightforward to understand why there is trepidation on the part of health insurance providers.
What mental conditions are typically covered, and not covered by health plans? Generally speaking, a health plan pays for only those services included in the plan’s list of covered services. In the case of mental health services, inpatient and outpatient treatment are most often covered by health plans.
However, there is a continuum of services between inpatient (mental health clinic) and outpatient care that effectively treat many mental disorders and are often more cost-effective than inpatient care at a mental health clinic.
These intermediate services include nonhospital residential services, partial hospitalization services, and intensive outpatient services such as case management and psychosocial rehabilitation. Psychosocial rehabilitation includes pharmacologic treatment, social skills training, and vocational rehabilitation.
Such services are covered by approximately half of employer-sponsored health plans.
Prescriptions. Are they covered? Coverage of prescription medications is also important in providing access to treatment for mental health disorders. And, on a positive note, Prescription medications are nearly always covered by health plans (U.S. Department of Labor, 1996; 1998), but this coverage is sometimes limited by formulary restrictions.
Check with your healthcare provider for the exact details on what applies to you and your family with regard to your specific circumstances.